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Ph Ger Alz & Osteo

Pharm Geriatrics

QuestionAnswer
Chol inhib dosing/timing Tacrine btw meals, Exelon with meals; Tacrine 4/d; donepezil 1/day, rivastigmine 2/d
Only chol inhib avail generically: Galantamine
Chol inhib also w/indication for PD: Rivastigmine
only chol inhib with indication for whole AD spectrum (Mild-Severe) Aricept
donepezil AE insomnia, GI
Exelon AE worst for GI (Tacrine bad for GI also)
Chol inhib DI Anticholinergics, beta, theophylline (level increased by tacrine)
NMDA monitoring Requires renal dose adjustment; CrCl <30: max dose 5 mg BID
Blocks excitatory effect of glutamate: NMDA antagonist
Alz: behavior disturbance: tx Cognitive Enhancers; Antidepressants; Antipsychotics; Others (Anticonvulsants, Benzo, Trazodone, Buspar, Propranolol)
Antipsychotics AE: sedation seen most with: quetiapine
Antipsychotics: AE 1G & risperidone (2G): EPS, tardive dyskinesia; ortho hypo, long QT, metab; Black box: CV, infxn
Meds assoc with delirium ACUTECHANGEINMS
ACUTECHANGEINMS: Anti-PD, C’steroid, Urologic (antispasmodics), Theophylline, (anti)Emetics, CV (antiarrythmics), H2 blockers (cimetidine), Anticholinergics, NSAID, geropsychotropic, EtOH, insomnia, narcotics, Mx relaxants, Seizure meds
Cognitive impairment: Meds are responsible for: 22-39% of delirium
More fractures occur in pts with: low bone mass (osteopenia) > osteoporosis
Bone density screening DEXA: W >65 & M >70; younger with RF (Low body wt, Prior fx, High risk med); h/o fx > 50 yo; RA and/or glucocorticoid use
Who gets osteoporosis tx Dx osteoporosis on BMD; hip/vert fx; Low bone mass (with other fx; with high-risk condition/med; FRAX 10-yr risk)
Bisphosphonates MOA inhibits bone resorption; act on osteoclasts; decreases rate of bone resorption => indirect increase in bone mineral density
Bisphosphonates CI Hypersensitivity; Hypocalcemia; Esophageal stricture; Inability to sit or stand upright for 30 minutes
Bisphosphonates dosing instructions empty stomach; >8 oz plain water, lots of water (no other liquid); 30-60 min before eat/drink; upright 30-60 min; check CrCl before IV
Bisphosphonates AE Hypocalcemia; Dysphagia; esoph inflame; Gastric ulcer; Visual disturbances; Osteonecrosis of the jaw; acute IV phase rxn (give Tylenol first)
Calcitonin MOA antagonizes parathyroid hormone, inhibits osteoclast bone resorption; nasal spray
Calcitonin AE rhinitis, epistaxis
Raloxifene MOA Selective estrogen receptor modulator; acts like estrogen to prevent bone resorption
Raloxifene AE DVT (CI if h/o VTE); Hot flashes; Edema; Arthralgia; Flu syndrome
Forteo MOA Anabolic, bone-building agent; Recombinant PTH, stimulates osteoblasts, increases calcium absorption and reabsorption
Tacrine: monitor: LFTs q3 mos (hepato tox risk)
Antichol inhib: CI hypersensitivity; jaundice (Tacrine)
Chol inhib: formulations Tacrine: caps; Exelon: has patch; Galantamine has soln
NMDA (memantine) dosing twice daily; titrate dose up each week; indication for mod-severe AD
NMDA AE dizziness, confusion, HA, constipation, cough, HTN; no DI's
NMDA: best effect in combo w/Aricept (but decline still happens over time)
AD behavior disturbances: don't respond to meds wandering; socially inappropriate behavior
AD: antipsychotics: sig improvement seen with: Haldol
Drug induced cog impairment: Mgmt Use least number of meds at lowest dose possible
Meds assoc w/bone loss Glucocorticoids; anticoag; anticonvulsants
Daily Vit D req 800-1000 IU D3
Alz med tx goals slow cognitive decline progression; preserve functional ability; diminish behav sx; educate pt & caregiver; improve QOL
zolendronic acid admin IV infusion over 15 min; once yearly
Created by: Abarnard
Popular Pharmacology sets

 

 



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